Background Facts
Ebeilda Ramirez suffered a work-related injury in 2006 when she was 32 years old. She experienced pain in her neck and lower back and over the next several years was treated with surgical procedures, epidural injections, nerve block
injections, and narcotic pain medication. Ramirez also suffered from additional maladies, including generalized anxiety disorder, irritable bowel syndrome (IBS), panic disorder, depression, asthma, mitral valve prolapse, and intussusception, for which she was prescribed a variety of medications. In 2010, she began complaining of severe abdominal pain, for which Dr. Lloyd Blakeman prescribed the narcotic hydrocodone, and he continued to prescribe hydrocodone for her into 2011. Dr. Blakeman eventually stopped authorizing refills of Ramirez’s hydrocodone prescription without an office visit, but Ramirez never came back to see him.
Ramirez then began seeing the defendant, Holly Carobene, M.D., on June 21, 2011, complaining of neck and back pain. At that time, she was taking hydrocodone three times per day. Dr. Carobene prescribed hydrocodone for Ramirez at her first appointment and did so without checking the Illinois Prescription Monitoring Program (PMP), which is an electronic database that collects, tracks, and stores reported dispensing data on controlled substances, including hydrocodone. The PMP allows a physician to look up a patient’s history of prescriptions for controlled substances. At her first appointment with Dr. Carobene, Ramirez signed a contract that: warned her that controlled substances, including narcotics, have a high potential for misuse; stated that medication that is lost, misplaced, stolen, or used up too quickly will not be replaced; required her to agree that she would not request or accept a controlled substance medication from another physician while receiving that medication from Dr. Carobene; and informed her that Dr. Carobene may determine that she needs to see a medication use specialist, who may recommend that the prescription not be continued.
Dr. Carobene continued to prescribe hydrocodone to Ramirez from 2011 until her death in 2015. During the course of their relationship, Ramirez reported to Dr. Carobene on several occasions that she had either finished her prescription early or lost her pills, and several times her urine tests revealed that she was negative for hydrocodone, indicating that she had not taken a hydrocodone pill within the last one-and-a-half to two days and had finished her prescription early.
At the conclusion of the Illinois medical malpractice wrongful death trial, the jury returned a general verdict in favor of the Estate, finding Dr. Carobene liable for total damages in the sum of $6 million. On motion of the Estate, the circuit court modified the judgment to assess an additional $647,999 in prejudgment interest.
The Appellate Court of Illinois First District Fourth Division stated in its January 16, 2025 Order: “The Estate’s experts testified to a reasonable degree of medical certainty that, had Dr. Carobene not prescribed hydrocodone to Ramirez, whether that be due to Ramirez’s drug-seeking behavior, her evidence of addiction and abuse, or her possible narcotic bowel syndrome, then Ramirez would not have died. Contrary to the Defendants’ claims, that testimony did not rely on any speculation … we believe that the Estate presented sufficient evidence that, absent Dr. Carobene’s actions, Ramirez would not have died and that Dr. Carobene’s conduct was, therefore, the cause in fact of Ramirez’s death … we ask whether it was reasonably foreseeable that prescribing hydrocodone to a patient who exhibits signs of misuse and addiction might result in that patient misusing the drug in a lethal manner. The answer to that question is yes … we must accept the Estate’s evidence that Ramirez died from acute hydrocodone toxicity, rather than from consequences of foreign material in her lungs. With that being the case, the focus is not on whether it was foreseeable that a patient would inject her medication into a PICC line, but rather whether it was foreseeable when Dr. Carobene prescribed hydrocodone to Ramirez in 2011 and 2012 that a patient whose behavior raised, in Dr. Engel’s words, “all of the red flags” suggesting abuse, misuse, and addiction would misuse her medication in any manner and succumb to hydrocodone toxicity. We think that a reasonable jury could find that it was, and that determination was for the jury to make … Accordingly, the Estate presented sufficient evidence establishing that Dr. Carobene’s violations of the standard of care were both the cause in fact and legal cause of Ramirez’s death, and the circuit court, therefore, did not err in denying the Defendants’ motion for JNOV on that issue.”
Source Ramirez v. Carobene, 2025 IL App (1st) 240203.
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